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Aim: This systematic review synthesizes and evaluates the literature regarding the effect of manual toothbrushes (MTBs) with cross-angled bristle tufts (CA-TB) compared to flat-trim (FT-TB) configurations on plaque scores and parameters of gingival health in adult patients., Materials and Methods: PubMed-MEDLINE and Cochrane-CENTRAL databases were searched, from their insertion up to August 1st, 2023, to detect appropriate papers. Clinical trials involving adult patients without periodontitis who performed self-brushing were eligible for inclusion. Primary outcome parameters included plaque, bleeding, and gingival scores. Secondary outcomes encompassed signs of soft and hard tissue abnormalities. A descriptive analysis was conducted. When feasible, a meta-analysis was performed using either the 'fixed' or 'random effects' model, as appropriate., Results: Nine eligible papers were retrieved, presenting 20 comparisons. There was considerable heterogeneity in the clinical and methodological design aspects of the included studies. In the descriptive analysis, eight out of 12 comparisons demonstrated a difference in plaque removal performance in favour of the CA-TB. However, data regarding bleeding and gingival index scores were inconclusive. A meta-analysis was performed on plaque, bleeding, and gingival index scores, including different indices used for scoring. The meta-analysis of short-term studies showed a medium effect statistically significant difference in the reduction of plaque scores in favour of the CA-TB (SMD = 0.75; 95% CI (0.51; 0.99)), but this was not substantiated in longer-term studies (SMD = -0.06; 95% CI(-0.44; 0.31)). No adverse events were described in any group., Conclusion: Within the limitations of the present study design, short-term evaluations, as assessed with various plaque indices, show a weak certainty in favour of the cross-angled toothbrush over the flat-trim toothbrush. However, based on longer-term evaluations, there is insufficient support due to the inconsistent outcomes of the analysis., (© 2024 The Authors. International Journal of Dental Hygiene published by John Wiley & Sons Ltd.)

Objective: To investigate characteristics of manual toothbrushes, self-toothbrushing methods, and replacement duration of manual toothbrushes that effectively remove dental plaque, reduce gingivitis, and promote gingival health., Study Data and Sources: PubMed-MEDLINE, Scopus and Central Register Cochrane of Controlled trials (CENTRAL) were searched for randomized control trials (RCTs) from 01 January 2018 to 12 December 2023. Articles were subjected for including participants aged six years and older with a study duration of at least four weeks to investigate the efficacy of manual toothbrushes used self-toothbrushing. To investigate the appropriate time to replace manual toothbrushes, this study was focused on the physical properties of the bristles and changes in the microorganisms present in the bristles over time., Study Selection: Of 1520 retrieved articles, 26 studies were included after screening. The total number of manual toothbrushes was 40 and 5 kinds of self-toothbrushing techniques were selected in the review. 4 studies investigated the changes the physical properties bristles of manual toothbrushes., Conclusions: Among manual toothbrushes, the cross-angle and indicator bristles were found to significantly improve dental plaque index and gingival condition. Most toothbrushes with soft bristles had a trend of superior dental plaque removal and gingivitis improvement efficacy. Toothbrush with end-round shape bristles tip has tended to reduce the dental plaque and gingival index scores. Studies reported that brushing twice a day for at least two minutes using the Bass method had a positive effect on the dental plaque and gingival index. Further research is required to investigate the relationships between property physical bristle and clinical intraoral indices to clarify the replacement duration of manual toothbrushes., Clinical Significance: The findings of this study could guide people's daily self-brushing habits, thereby aiding the prevention of periodontal disease. Moreover, our findings suggest the need for strategic clinical trial designs to verify the ideal timing to replace manual toothbrushes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

China has been recognized as an important birthplace of dentistry in the world. The bone toothbrush from ash pits in the museum of the Chengdu University of Traditional Chinese Medicine confirms that the Chinese had the awareness of cleaning their teeth and the tools to do for over 1000 years. These findings help to promotes the study of the historical development of dentistry in China., (Copyright 2024 © American Academy of the History of Dentistry.)

Objectives: For people, it is challenging to be conscious of the appropriate toothbrushing time to maintain good oral health in daily life. The aim of this study was to preliminarily examine the utility of an application (app) that combines a toothbrushing timer and information on toothbrushes., Materials and Methods: We developed the "Toothbrushing Timer with Information on Toothbrushes" app to help users ensure appropriate toothbrushing time and learn about the beneficial characteristics of toothbrushes. A total of 18 participants were registered for the study. At baseline (T0) and after 1 month (T1) of app usage, study participants answered a digital questionnaire that comprised three questions on oral health practice, self-efficacy in oral hygiene, and quality of life related to oral health (Oral Health Impact Profile-14 [OHIP-14])., Results: Five participants were excluded from the analysis as they did not answer the digital questionnaire. Finally, 13 participants completed the survey with a follow-up of 1 month. The 13 participants were grouped into health professionals (n = 8) and non-health professionals (n = 5). The total scores for oral health practice and self-efficacy related to oral hygiene increased after a month of app usage in health professional and non-health professional groups. However, there were no significant differences between T0 and T1 in either group. The total score of OHIP-14 was lower at T1 than at T0 in both groups. Therefore, participants showed better oral health practice, self-efficacy in oral hygiene, and quality of life related to oral health at T1 compared with that at T0., Conclusions: Our app showed positive results for the users and is useful in maintaining and promoting oral health awareness and practice. However, our pilot study lacks sufficient power and did not yield significant differences. Therefore, high-quality clinical trials with larger sample sizes are warranted for further improvement and evaluation., (© 2023 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Introduction: This study was performed to evaluate the effects of varying brushing times on the dental plaque-removal efficacy of a power toothbrush to determine the optimal length of time required to brush the teeth., Methods: A typodont with 32 teeth was divided into four quadrants and further divided into four zones each (two teeth per zone). Using a robotic arm, toothbrushing was performed over eight different brushing times (0, 60, 120, 180, 240, 300, 360, and 420 s) to remove the artificial plaque applied on the labial surface of the teeth in occlusion. Photographs were taken every 60 s from each zone of the typodont. The images obtained were processed using ImageJ software to measure the percentage of remaining plaque. Data were analysed with factorial ANOVA, least squares regression analysis, and post hoc Tukey tests., Results: Plaque removal significantly increased with brushing time across the brushing intervals studied (p < 0.05). Efficient plaque removal was achieved after 240 s of brushing. There was no significant difference in plaque accumulations between the maxillary and mandibular arch (p = 0.19) and the right and left areas after each time interval (p = 0.49)., Conclusion: Brushing duration is negatively correlated with the remaining plaque for a given toothbrush. Two minutes of brushing is not sufficient for significant plaque removal. Considering the limitations of this in vitro study, clinical studies are needed in order to change brushing recommendations to 240 s., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The use of a toothbrush with radio frequency (RF) has shown to be of benefit regarding the reduction of plaque, calculus, and dental staining and improving teeth shade compared to conventional powered and manual toothbrushes., Aim: To evaluate the efficacy of the RF toothbrush in the reduction of calculus accumulation and its effect on periodontal parameters as well as subject satisfaction as compared to an identical sham-tooth brush., Materials and Methods: Patients who are under a strict maintenance program were included. Patients were allocated to test (RF toothbrush) or control (sham) randomly and were examined at baseline, one and three months. Clinical photos were taken and a consequential calculus assessment via ImageJ software. Clinical assessment included the following: plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and recession (REC). Patient satisfaction was assessed via a questionnaire., Results: Fifty-eight patients (29 control, 29 test) were included. At baseline mean PPD, BOP, PI, REC, and calculus accumulation were similar between the groups. Mean buccal calculus was lower in the test group at one month 4.0% versus 6.7%, p < .05. Calculus accumulation within the groups was lower in the test group at 1 and 3 months when compared to baseline at the buccal aspect (2.8% vs. 8.9%, p < .05% and 3.8% vs. 8.9%, p < .05) and lingual aspect (6.7% vs. 16.5%, p < .05% and 8.9% vs. 16.5%, p < .05). No statistically significant results were found regarding periodontal parameters PPD, BOP, PI, and REC. No difference was found between groups regarding patient satisfaction., Conclusion: RF seems to have an additive effect on preventing calculus accumulation on the buccal aspect of anterior mandibular teeth at 1 month. Nevertheless, at 3 months, no difference between the toothbrushes is seen regarding calculus formation and maintaining periodontal health (ClinicalTrials.gov, Identifier NCT04640857)., (© 2023 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Objectives: To assess the efficacy of a new toothbrush (Balene) for the mechanical removal of dental plaque in patients with acquired brain injury., Material and Methods: The study group consisted of 25 adults with acquired brain injury. The participants underwent 2 sessions of toothbrushing lasting 1 min, one with a conventional toothbrush and the other with the Balene toothbrush. This new double-headed toothbrush has 6 active sides, which allows for the simultaneous toothbrushing of both alveolar arches, with elastomer bristles angled at 45°, as well a handle that rotates up to 180°. Therefore, the user does not need to remove the toothbrush from the oral cavity during the toothbrushing process. Dental plaque accumulation was assessed using the simplified oral hygiene index of Greene and Vermillion., Results: The plaque index was significantly reduced both with the Balene toothbrush (p < 0.001) and with the conventional toothbrush (p < 0.001). The dental plaque removal efficacy was similar with the two toothbrushes. There were also no statistically significant differences in the removal of plaque with the Balene toothbrush between the autonomous and assisted toothbrushing modalities (p = 0.345)., Conclusions: For patients with acquired brain injury, the Balene toothbrush was as effective as a conventional toothbrush, regardless of whether the toothbrushing modality was autonomous or assisted., Clinical Relevance: The Balene® toothbrush's efficacy in removing dental plaque is similar to that of conventional toothbrushes, both with the autonomous and assisted toothbrushing modality. Given its particular ergonomics, this toothbrush could be indicated for certain select patients with acquired brain injury (i.e., those whose degree of cooperation allows for toothbrushing, with a sufficient mouth opening, with no substantial abnormalities in the intermaxillary relationship, and with no significant edentulous sections)., (© 2023. The Author(s).)

Objective: This study aims to evaluate three types of manual toothbrushes [Cross action (CA), Flat trim (FT), and orthodontic type (OT)] in terms of efficacy in plaque removal in patients undergoing fixed orthodontic treatment., Background: Manual toothbrushes are an essential part of oral hygiene for primary prevention. Plaque control, however, can be influenced by a number of individual and material-related factors. Individual factors include the presence of fixed orthodontic appliances on tooth surfaces, such as brackets and bands, which create difficulties with oral hygiene and lead to plaque formation. The evidence for the effectiveness of advanced bristle designs (multilevel, criss-cross) of the manual toothbrush alone in removing plaque in patients undergoing orthodontic therapy is limited., Methods: The experiment followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. This was a three treatment, three-period crossover clinical trial with a single brushing exercise. Thirty subjects were randomized to one of the three treatment sequences of different bristle designs: (CA, FT, and OT). The primary outcome measure was the difference in the plaque scores (baseline minus post-brushing) at each study period, as determined by the Turesky-Modified Quigley-Hein Plaque Index., Results: Of the thirty-four subjects enrolled in the study, thirty of the subjects met the inclusion criteria and completed all three periods of the study. The mean age was 19.5 ± 1.52 years, with a range of 18-23 years. The differences between treatments in plaque score reduction after brushing were statistically significant (p-value < .001). The treatment differences were statistically significant (p-value < .001) favoring the FT toothbrush over the OT and CA types of toothbrush designs. On the contrary, the difference between the OT and CA types was not statistically significant., Conclusions: Plaque was significantly removed by the conventional FT toothbrush after a single brushing compared to the OT and CA types., (© 2023. The Author(s).)

Purpose: This study investigated the effect of toothbrush bristle stiffness and brushing force on the cleaning efficacy in vitro., Materials and Methods: Eighty bovine dentin samples were allocated to eight groups (n=10). Two custom-made toothbrushes of different bristle stiffness (soft and medium) were tested at four different brushing forces (1, 2, 3 and 4 N). Dentin samples were stained in black tea and brushed (60 strokes/min) for a total of 25 min in a brushing machine with an abrasive solution (RDA 67). Photographs were taken after 2 and 25 min of brushing time. Cleaning efficacy was measured planimetrically., Results: After 2 min of brushing, the soft-bristle toothbrush did not cause statistically significantly different cleaning efficacy at different brushing forces, while the medium-bristle toothbrush cleaned statistically significantly less efficaceously only at 1 N. Comparing the two different toothbrushes, higher cleaning efficacy was observed only at 1 N for the soft-bristle brush. At 25 min brushing time, the soft-bristle cleaned statistically significantly better at 4 N compared to 1 N and 2 N and at 3 N compared to 1 N. Using the medium-bristle, cleaning efficacy increased with increasing brushing force. After 25 min of brushing, no statistically significant difference was observed between the two different toothbrushes., Conclusion: Irrespective the brushing force, the use of a soft or medium toothbrush results in comparable cleaning efficacy. At 2 min brushing time, increasing the brushing force does not increase the cleaning efficacy.

Purpose: To compare the plaque-removal efficacy of ultra-soft single-headed, triple-headed, and T-shaped toothbrushes and the subjective perceptions of users., Methods: In this randomized, single-blind, crossover study, 30 healthy adult participants were randomly divided into three groups of 10, who tested the three types of toothbrushes in differing order, with a 1-week washout period between the tests. Dental plaque scores were recorded before and after toothbrushing, and questionnaires on subjective perceptions after toothbrushing were collected., Results: The participants included 16 female participants and 14 male participants (average age: 29.4 ± 6.7 years). All three toothbrush types were effective in reducing dental plaque by 36-46%; however, the cleaning effect of the ultra-soft single-headed toothbrush was inferior to that of the triple-headed and T-shaped toothbrushes, the difference being statistically significant. The users' subjective perceptions suggested that the ultra-soft single-headed toothbrush was significantly superior to the other two toothbrush types. Plaque scores for the lower posterior tooth surfaces were higher than those for the upper posterior tooth surfaces, particularly on the left side, for both the ultra-soft single-headed and T-shaped toothbrushes., Conclusion: Healthcare practitioners should identify the type of toothbrush bristles used by individuals and provide appropriate oral health information.

Background and Objectives : The aim of this in vitro study was to evaluate the effect of gastric acid associated with the effect of toothbrushing on the surface roughness of different types of composite resin used for direct restorations. Materials and Methods : The materials used in this study were two microhybrid (Filtek Z250, Herculite XRV) and two nanohybrid (Filtek Z550, Herculite XRV Ultra) composite resins. Two hundred and forty cylindrical samples with a height of 2 mm and a diameter of 6 mm were divided into four groups (groups A, B, C and D) corresponding to each tested material (n = 60). Each group was divided in two subgroups: subgroup I-the samples were submersed in hydrochloric acid and immediately submitted to toothbrushing; subgroup II-the samples were submitted only to toothbrushing. The simulation of the acid attack was performed by immersing the samples in a 0.01 M hydrochloric acid solution for 90 min. This procedure was followed immediately by toothbrushing simulation with 10,000 cycles. The acid attack and toothbrushing simulation were performed for two times. The surface roughness evaluation was performed with a Proscan 2100 profilometer. Repeated Measures ANOVA and Bonferroni post-hoc tests were used to perform the statistical analysis. Results : Simulation of one year of toothbrushing associated or not to hydrochloric acid exposure increases the surface roughness of microhybrid and nanohybrid composite resins. Six months of toothbrushing associated to six months of hydrochloric acid exposure increase the surface roughness of nanohybrid composite resins. Conclusions : Microhybrid composite resins surface becomes rougher after toothbrush and acid submersion when comparing to nanohybrid composite resins.

Background and Objectives: The aim of this in vitro study was to evaluate the effect of simulated gastric acid associated with toothbrushing on the surface condition of three resin-modified glass-ionomer cements (RMGIC). Materials and Methods: One hundred and sixty samples of each material were obtained and included in three study groups according to the tested material: Group I (Ionolux, VOCO GmbH, Cuxhaven, Germany); Group II (Vitremer, 3 M-ESPE, St. Paul, MN, USA); and Group III (Fuji II LC, GC Corporation, Tokyo, Japan). The samples were submersed in hydrochloric acid 0.01 M (pH 3.8) for 3 h and exposed to a toothbrushing procedure at a frequency of 10,000 cycles with medium and hard bristles immediately or 30 min after the acid attack. Profilometric measurements were performed by using a non-contact profilometer (Dektak XT, Bruker, Billerica, MA, USA) in order to assess the surface roughness. ANOVA and Bonferroni post hoc tests were used for the statistical analysis at a significance level of p < 0.05. Results: Exposure of RMGICs to the erosive effect of hydrochloric acid in association with toothbrushing 30 min after the chemical attack increased the surface roughness of all three RMGICs. Exposure of the three tested materials exclusively to the action of hydrochloric acid did not affect the surface roughness. Conclusions: One year of hydrochloric acid challenge associated with one year of toothbrushing with medium-hardness bristles performed 30 min after the acid attack increase the surface roughness of two of the three types of RMGIC tested (Ionolux and Fuji II LC).

Objective: To investigate the effect of toothbrush bristles end configuration on the abrasive dentine wear at different brushing forces., Material and Methods: One hundred and sixty bovine dentine samples were randomized into eight groups ( n  = 20). Groups (1 to 4) were brushed with tapered-end bristles at 1-, 2-, 3-, and 4-N brushing forces, respectively. Groups (5 to 8) were brushed with round-end bristles with the same brushing forces. The brushing sequence was carried out using an abrasive slurry (RDA = 121) for 25 min. Profiles were recorded using a contact profilometer. Mean and standard deviation were calculated for the abrasive dentine wear in each group. Two-way ANOVA was used to locate any significance. The significance values were corrected after Tukey (α = 0.05)., Results: Brushing with tapered-end bristles resulted in statistically significantly less abrasive dentine wear than round-end bristles regardless of the applied brushing force (1 N: 4.4 ± 1.5 vs. 7.7 ± 2.0 µm; 2 N: 7.7 ± 2.1 vs. 12.2 ± 2.7 µm; 3 N: 11.3 ± 2.6 vs. 19.4 ± 3.7 µm; 4 N: 11.2 ± 2.1 vs. 25.3 ± 4.8 µm). The interaction between bristle configuration and brushing force was statistically significantly ( p  < 0.001)., Conclusion: Tapered-end toothbrushes might be a safer choice for patients, especially when showing signs of non-carious cervical lesion. However, other toothbrush properties should also be considered.

Non-carious cervical lesions (NCCLs) are saucer-shaped abrasions of a tooth. NCCLs can form due to various etiologies, including toothbrushing wear, acid erosion, and mechanical stress. Owing to this complex interplay, the mechanism of NCCLs in tooth abrasion has not been established. This study aims to develop a numerical method using a computational toothbrush to simulate NCCLs. The forces acting on the teeth and the amount of abrasion generated were evaluated. The discrete element method using in-house code, connected particle model, and Archard wear model were applied for brushing. In the toothbrush model, 42 acrylic tufts were fixed into a toothbrush head. The teeth models with enamel properties comprised four flat plates and two grooves to simulate the anterior teeth and NCCLs. The brushing speed and depth for one cycle were established as simulation parameters. The force applied within the ununiform plane was concentrated on several bristles as the toothbrush passed through the interproximal space. The brushing force (depth) had a greater effect on tooth abrasion than the brushing speed. Toothbrushing abrasion was mainly concentrated in the interproximal space. Therefore, forceful tooth brushing can cause NCCLs from the interproximal space to the cervical area of the tooth.

Background: To evaluate an experimental T-shaped toothbrush for plaque removal and gingival health when compared to a conventional toothbrush among children., Methods: This single blind parallel randomized controlled trial was conducted on 8-10-year-old healthy schoolchildren with no history of recent antibiotic intake, proximal caries or more than 3 missing teeth per quadrant. A computer-generated randomization list allocated child to the 2 groups. Each child received detailed instructions for tooth brushing. Gingival health and plaque scores were recorded in school at baseline, 2 weeks, 1 month and 3 months in a portable dental chair by an examiner who was blind to the allocated toothbrush. A general feedback on the use of the T-shaped toothbrush was obtained at 3 months. Data was analyzed using two-way repeated measure ANOVA, Generalized estimating equation and Bonferroni test., Results: A total of 195 eligible children were invited, 110 parents gave consent and 100 children completed the study; 50 in each group. There were statistically significant reductions in mean gingival and plaque scores at each visit when compared to baseline for both toothbrushes (p < 0.05). There were no statistically significant differences between scores for the two toothbrushes at each visit (p > 0.05). Majority of participants gave positive feedback regarding the T-shaped toothbrush., Conclusions: Both toothbrushes had similar efficacy in removing plaque and improving gingival health among children. The T-shaped toothbrush is an alternative to the conventional toothbrush for oral hygiene in children. Trial registration Retrospectively registered at ClinicalTrials.gov Registry-NCT03989479 18/06/2019., (© 2022. The Author(s).)

Article Title and Bibliographic Information: Slot DE, Valkenburg C, Van der Weijden GAF. Mechanical plaque removal of periodontal maintenance patients: A systematic review and network meta-analysis. J Clin Periodontol. 2020 Jul;47 Suppl 22:107-124. doi:10.1111/jcpe.13275. PMID: 32716118., Source of Funding: The authors declare that they have no conflicts of interest. However, Van der Weijden, Slot, and their research team at ACTA have previously received either external advisor fees, lecturer fees, or research grants from toothbrush, dentifrice, and interdental devices manufacturers. Those manufacturers included: Braun AG, Colgate, Dentaid, GABA, Lactona, Oral-B, Philips, Procter & Gamble, Sara Lee, TePe, Sunstar, Water Pik, and Unilever., Type of Study/design: Systematic review with network meta-analysis., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Few studies have reported the use of toothbrushes as a reliable source of DNA for human or gender identification. The present systematic review with the available information was conducted to answer the focus question "Is a toothbrush a reliable source of DNA for human or gender identification?"., Methods: The keyword combination "Toothbrush" and "DNA" was used to search databases including MEDLINE, Scopus, and Web of Science along with a manual search of reference lists of relevant articles. Duplicates and irrelevant articles were excluded, and the remaining articles were fully read for the final selection of articles. The risk of bias of the included studies was evaluated using the Appraisal tool for Cross-Sectional Studies (AXIS tool)., Results: Of the 130 articles obtained, 122 duplicates or irrelevant articles were eliminated. Following the full-text reading of eight articles, five articles were selected based on eligibility criteria. The five studies reported that a toothbrush is a good source of DNA irrespective of the time interval. In a few studies some samples were not sufficient for complete DNA profiling due to factors such as the method of DNA extraction., Conclusion: Although a toothbrush is an excellent source of DNA for human and gender identification, future studies with a larger sample size, appropriate control group, and standardized technique of DNA extraction need to be conducted. Additionally, factors influencing the quantity and quality of DNA in toothbrushes need to be determined with standardized techniques.

Background: While indoor microbiomes impact our health and well-being, much remains unknown about taxonomic and functional transitions that occur in human-derived microbial communities once they are transferred away from human hosts. Toothbrushes are a model to investigate the potential response of oral-derived microbiota to conditions of the built environment. Here, we characterize metagenomes of toothbrushes from 34 subjects to define the toothbrush microbiome and resistome and possible influential factors., Results: Toothbrush microbiomes often comprised a dominant subset of human oral taxa and less abundant or site-specific environmental strains. Although toothbrushes contained lower taxonomic diversity than oral-associated counterparts (determined by comparison with the Human Microbiome Project), they had relatively broader antimicrobial resistance gene (ARG) profiles. Toothbrush resistomes were enriched with a variety of ARGs, notably those conferring multidrug efflux and putative resistance to triclosan, which were primarily attributable to versatile environmental taxa. Toothbrush microbial communities and resistomes correlated with a variety of factors linked to personal health, dental hygiene, and bathroom features., Conclusions: Selective pressures in the built environment may shape the dynamic mixture of human (primarily oral-associated) and environmental microbiota that encounter each other on toothbrushes. Harboring a microbial diversity and resistome distinct from human-associated counterparts suggests toothbrushes could potentially serve as a reservoir that may enable the transfer of ARGs. Video abstract.

Background: Biting objects was a parafunctional oral habit among children with special care needs. Chewing or biting toothbrushes could expedite the process of toothbrush wear. However, few studies evaluated the deterioration levels of toothbrushes used by children with special needs. This study aimed to assess the deterioration level of toothbrushes used by children with special care needs, and collect parents' feedbacks to improve the design of children's toothbrushes., Methods: The cross-sectional study recruited 277 children who had special care needs. Children's toothbrushing behaviors, background information, and parents' comments on toothbrushes were obtained. Toothbrush deterioration was assessed by bristle wear and bite mark scores. Higher scores indicated severe deterioration., Results: Three hundred twenty-one toothbrushes were collected. Children who used 2 to 6 toothbrushes in a 3-month period showed higher toothbrush deterioration scores than children who used a single toothbrush. Over 40% children's toothbrushes presented excessive wear. Excessive wear was associated with social skills and parents' education background. Distinct bite marks tended to exist on toothbrushes which had been used by children who showed challenging behaviors during toothbrushing (OR = 1.96, 95%CI1.15-3.32, p < 0.05). Approximately 27% parents reported that children's toothbrushes should be modified. Parents recommended that the size of toothbrush heads, the angle of handles, and the texture/length/distribution/diameter of bristles should be adjusted. Besides, ideal toothbrushes should be able to provide verbal or visual instructions to children, motivate children to brush teeth, simplify toothbrushing procedure, and protect children who had toothbrush-biting habits., Conclusions: Excessive wear and distinct bite marks can be found on toothbrushes that had been used by children with special care needs. Toothbrush deterioration was associated with children's social skills, toothbrushing behaviors, and parents' educational attainment. The commercially available toothbrushes should be modified to meet the additional needs of young children.

Over the past two decades, Ag and Zn nanoparticles have been integrated into various consumer products as a biocide. While some nano-enabled consumer products have been shown to have antibacterial properties, their antibacterial efficacy as well as the human and environmental health outcomes are not fully known. In this study, we examine a nanoparticle-enabled product that also serves as a conduit for human exposure to bacteria: toothbrushes. We utilize a combination of chemical analyses, laboratory experiments, and microscopy to characterize the nano-enabled toothbrush bristles. Our analysis showed the majority of measured Ag and Zn particles ranged from approximately 50 to 100 nm in size and were located on the surface and within bristles. During simulated brushing, antimicrobial bristles released both Ag and Zn, the majority of which was released in particulate form. While our results demonstrate that antimicrobial bristles have enhanced bactericidal properties compared to control samples, we also show that the surface topography influences nanoparticle retention, microbial adhesion, and bactericidal activity. We thus conclude that Ag or Zn content alone is insufficient to predict antimicrobial properties, which are further governed by the bioavailability of Ag or Zn at the bristle surface., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier B.V.)

Tooth brushing is necessary to maintain oral health. Little research has been carried out to explore microbial diversity in toothbrushes and to study the potential impact of these bacteria on human health. In the present study, 20 participants were enrolled, and the microbial diversity in their oral cavity and toothbrushes was investigated using high-throughput sequencing. Our results indicate that 1,136 and 976 operational taxonomic units (OTUs) were obtained from groups CB (samples from toothbrushes of participants using traditional Chinese medicinal toothpaste) and AB (samples from toothbrushes of those using antibacterial toothpaste), respectively. The pathogens Acinetobacter baumannii, Staphylococcus aureus , and Candida albicans were identified on toothbrushes. The presence of these pathogens increases the chance for the host to get infectious diseases, neurodegenerative diseases, cardiovascular diseases, and cancers. Moreover, our in vitro results indicate that traditional Chinese medicinal toothpaste and antibacterial toothpaste can not only inhibit the growth of pathogens but also markedly inhibit the growth of probiotics Lactobacillus salivarius and Streptococcus salivarius . Therefore, the inhibitory effect of toothpaste on probiotics, together with the existence of pathogens in toothbrushes, indicates a potential risk of tooth brushing for people in a sub-healthy state., (Copyright © 2020 Shang, Gao, Qin, Wang, Shi and Chen.)

Objective: The objective of this trial was to compare the plaque removal ability of a triple-headed toothbrush to a conventional manual toothbrush in adolescents with fixed orthodontic appliances., Materials and Methods: Sixty adolescent patients undergoing orthodontic treatment were randomly assigned to brush one time with either a conventional manual toothbrush or a triple-headed toothbrush. The main outcome was the post-brushing plaque index as measured by the Silness-Löe plaque index., Results: Sixty patients (mean age, 14.2; standard deviation, 1.65) were randomized in a 1:1 ratio to either a manual toothbrush group or a triple-headed toothbrush group. Baseline characteristics were similar between the two groups. There were no dropouts. The mean post-brushing plaque index was 0.84 (95% CI, 0.67-1.02; SD, 0.60) for the conventional manual toothbrush group, and 0.31 (95% CI, 0.13-0.49; SD, 0.48) for the triple-headed toothbrush group. There was a statistically significant difference in the mean plaque index of 0.53 (95% CI, 0.28-0.78; P<0.001) between the two groups after brushing. No harms were observed., Conclusion: The results of this study indicate strong evidence that the triple-headed toothbrush leads to a significantly lower plaque index compared to the conventional manual toothbrush post-brushing., (Copyright © 2019 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Objective: This study investigated the effect of toothbrush stiffness and dentifrice slurry abrasivity on the development and progression of simulated non-carious cervical lesions (NCCLs)., Materials and Methods: Human maxillary premolars were allocated to 12 groups generated by the association between toothbrushes, soft, medium, and hard stiffness, and simulated dentifrice slurries, lower, medium, and higher; deionized water (DI) served as negative control. Teeth were mounted on acrylic blocks, and their root surfaces partially covered with acrylic resin to simulate gingiva, leaving a 2-mm area apical to the cemento-enamel junction exposed to toothbrushing. Specimens were brushed with the test slurries for 35,000 and 65,000 double strokes. Impressions taken at baseline and after both brushing periods were scanned by a 3D optical profilometer. Dentin volume loss (mm 3 ) was calculated by image subtraction. Data were analyzed using three-way ANOVA and Fisher's PLSD tests., Results: All toothbrushes caused higher volume loss when associated to higher abrasive slurry, compared to medium- and lower-abrasive slurries. Medium caused more volume loss than lower-abrasive slurry, which led to more volume loss than DI. Hard and medium toothbrushes were not different when used with medium- or higher-abrasive slurries. There were no differences among toothbrushes when used with DI and lower-abrasive slurry. Overall, 35,000 brushing strokes resulted in significantly less volume loss than 65,000., Conclusions: Toothbrush stiffness was an important factor on NCCL development, especially when brushing with medium- and higher-abrasive slurries., Clinical Relevance: Medium and hard toothbrushes associated with medium- and high-abrasive toothpastes can yield more severe NCCLs.

Objectives: This study investigated the effect of toothbrush bristle configuration and brushing load on the development of non-carious cervical lesions (NCCLs)., Methods: Human premolars were mounted on acrylic blocks and had their root surfaces partially covered with acrylic resin to simulate gingiva, leaving a 2-mm length area apical to the cemento-enamel junction exposed for brushing. The teeth were brushed under 1- or 3 N load with one of the following toothbrushes (n = 16): a) ordinary/flat-trimmed (Oral-B Indicator); b) rippled (Oral-B Contour); c) cross-angled/multileveled/rubber bristles (Oral-B Pro-Health All-in-One); d) cross-angled/multileveled/flex head (Oral-B Pro-Flex); e) feathered (Oral-B Compact Clean). Brushing was performed using toothpaste slurry (Crest Cavity Protection) for 55,000 double-strokes in back-and-forth motion, to simulate 10 years of brushing. Impressions were taken at baseline and after brushing and scanned by a 3D optical profilometer. The lesions formed were evaluated for volume loss, angle, and shape., Results: The ordinary/flat-trimmed toothbrush caused significantly higher volume loss (3.81 mm 3 ) in comparison to the other toothbrushes (2.56-2.92 mm 3 ). The toothbrush having rubber bristles was associated with NCCLs showing the smallest angle and, along with the rippled toothbrush (53.1%), provoked higher proportion of wedge-shaped lesions (43.8%), whereas teeth brushed with the feathered toothbrush exhibited the lowest prevalence of wedge-shaped lesions (3.1%). The 1- and 3 N load applied during brushing affected neither volume loss nor lesion angle., Conclusions: At the brushing loads tested, the development of NCCLs was dependent on toothbrush bristle configuration, with the ordinary/flat-trimmed version causing the highest abrasion and the feathered toothbrush the least proportion of wedge-shaped lesions., Clinical Significance: Toothbrush bristle arrangement plays a role in NCCL development, with the ordinary/flat-trimmed version being more abrasive and the feathered toothbrush causing less wedge-shaped lesions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Many dermatologic procedures are painful and traumatic, for both pediatric patients and providers alike. Vibration anesthesia has recently been discussed as an effective method for reducing pain associated with injections, but some vibration machines can be cost prohibitive for providers. We describe how to employ an electric toothbrush as an inexpensive and effective option to provide vibration anesthesia during painful pediatric procedures., (© 2019 Wiley Periodicals, Inc.)

This study evaluated surface gloss, roughness and color change of six current flowable composites after simulated toothbrushing, including four traditional flowable composites (i.e. GrandioSO Flow, Arabesk Flow, Kerr Revolution Formula 2 and Gradia Direct LoFlo), one self-adhering flowable composite (Kerr Vertise Flow) and one universal injectable composite (G-ænial Universal Flo). Forty-eight dimensionally standardized specimens (n=8/group) were made from six composites. Before and after 1 h toothbrushing simulation, surface gloss was measured with a glossmeter, and surface roughness was evaluated with a profilometer, and color was measured with a spectrophotometer. In this study, G-ænial Universal Flo, termed as universal injectable composite by the manufacturer, presented excellent surface properties after toothbrush abrasion; Gradia Direct LoFlo showed excellent color stablity after toothbrush abrasion; color alteration of composites caused by toothbrush abrasion was acceptable on the premise that 3.3∆E units were considered as acceptable threshold values.

Aim: This systematic review was performed to establish the effect of a manual toothbrush with tapered toothbrush filaments (TFTBs) compared to a manual toothbrush with end-rounded toothbrush filaments (ERTB) on clinical parameters of dental plaque, gingivitis and gingival abrasion., Materials and Methods: MEDLINE-PubMed and Cochrane-CENTRAL databases were searched. The inclusion criteria were (randomized) controlled clinical trials, participants ≥18 years and papers evaluating the effect of a TFTB compared to an ERTB. Data were extracted for dental plaque index (PI), bleeding scores (BS), gingival index scores (GI) and gingival abrasion scores (GA). A descriptive analysis and a meta-analysis were performed when appropriate., Results: An independent screening of 33 unique papers resulted in seven eligible publications, which included eight comparisons. Meta-analysis did not show a significant difference between TFTB and ERTB with respect to PI scores. The meta-analysis of the GI scores showed a significant mean difference in favour of the TFTB (DiffM=-0.12 [95% CI: -0.17; -0.07]). Of the three comparisons evaluating GA, no differences were found., Conclusion: With respect to plaque removal, evidence that supports the recommendation for usage of a TFTB over an ERTB is lacking. Regarding GI, there is minimal evidence favouring a TFTB over an ERTB and the clinical relevance of this difference is probably negligible. Therefore, based on the collective evidence emerging from this systematic review, the strength and direction of the recommendation, there appears to be no firm evidence for a dental healthcare professional to advise the use of a TFTB over the use of an ERTB., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Toothbrushes are the most common cause of foreign body injury to the oral cavity in children, but complete impalement by a toothbrush is an extremely rare occurrence and has not been reported previously. This report describes a 28-month-old girl who fell from a 1m ledge while brushing her teeth. Her toothbrush penetrated the oral cavity and could not be removed, and so she was rushed to the hospital with the toothbrush in place. Contrast-enhanced computed tomography showed penetration of the toothbrush from the oral cavity into and through the right posterior neck at the level of the bifurcation of the common carotid artery. Angiography was performed under general anesthesia, and the toothbrush was removed. In consultation with pediatricians, antibiotic infusion therapy was started, and the patient was extubated on the 5th post-operative day. There were no complications even after eating was resumed, and the patient was discharged on the 13th post-operative day. A toothbrush is an essential item in daily life, but it can cause serious injuries in children in some circumstances., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aim of this study was to evaluate the proportions of end-rounded bristles via observations of the end patterns of various children's toothbrushes with scanning electron microscopy (SEM) and stereomicroscopy., Methods: Ten different brands of children's toothbrushes were chosen, and tufts from each toothbrush were used. The prepared bristle specimens were observed on SEM and stereomicroscopic images and classified as acceptable (A1-A3) and non-acceptable (N1-N5) according to the modified classification. Then, the proportions of end-rounded bristles were calculated., Results: Analyses of the 10 toothbrushes revealed that the proportions of acceptable end-rounded bristles ranged from 1.4% to 20.2% on SEM and from 0.0% to 18.0% on stereomicroscopic examinations. Additionally, some toothbrushes had labels that indicated bristle end-rounding, but the proportions of end-rounded bristles were low., Conclusions: The types and percentages of bristle ends of children's toothbrushes marketed in Korea were various, but the amount of acceptable end-rounded bristles was low. The result, that even toothbrushes labelled as end-rounded had potential to harm oral tissue, demonstrates that quality control for rounding bristle ends as well as the labelling for end-rounded bristles is needed., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This study investigated the effect of tooth brushing force on changes in dentine tubule patency in an erosion-toothbrush abrasion model., Methods: 60 dentine samples prepared with an artificial smear layer and divided randomly into control (no toothbrush), 100 g, 200 g or 400 g toothbrush groups. They were immersed in 3:1 artificial saliva/NaF 1450 ppm and either brushed (p35 soft tooth brush; 120 strokes) or not brushed. Then samples were subjected to agitated acid challenge (0.3% citric acid pH2.6 for 2 min). Finally, samples were re-brushed. Calibrated software calculated patent dentine tubules that cause DH in confocal microscopy images taken of samples at each stage., Results: At baseline, mean patent tubules in all samples were 188 (SD54) with no significant inter-group differences. Following first brushing, mean patent tubules decreased using 100 g to 150 (SD32) (p<0.01) and increased using 400 g to 215 (SD45) (p=0.02). Following acid challenge, patent tubules increased to 218 (SD40) in all samples (p<0.01) with no significant inter-group differences. Following further brushing, mean patent tubules decreased using 100 g to 175 (SD72) (p<0.01), but increased with 400 g to 232 (SD52)., Conclusions: At higher brushing forces (400 g), more tubules were exposed. At lower brushing forces (100 g), tubule patency decreased even post-acidic challenge., Clinical Significance: It is often recommended to our patients with DH to brush using lighter brushing forces but our understanding of this force on dentine tubule patency is unknown. The management of DH requires lighter brushing forces to reduce the numbers of patent dentine tubules., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: The aim of this clinical investigation was to identify and quantify the microbial species adhering to toothbrush bristles after controlled brushing and storage in different antimicrobial agents., Methods: Sixteen healthy participants were enrolled in this study and randomly submitted to 4 interventions in a cross-over design: brushing and toothbrush storage in (I) Periogard/(II) Periobio (Chlorhexidine gluconate 0.12%), (III) Cepacol (cetylpyridinium chloride 0.05%) and (IV) distilled water (positive control). Thirty-eight bacterial species including putative pathogens and 5 Candida spp. were assessed by Checkerboard DNA-DNA hybridization., Results: The results of the study have shown a striking reduction of the total microbial counts, including bacteria and Candida spp., on the toothbrush bristles after storage in cetylpyridinium chloride 0.05% (p < 0.0001). Chlorhexidine gluconate 0.12% showed no differences on the total bacterial count when compared to distilled water (p > 0.05). Cetylpyridinium chloride solution also presented the lowest genome counts and frequency of detection for individual target species; distilled water showed the highest individual genome counts (p < 0.05). Potential pathogenic species were recorded in moderate to high levels for chlorhexidine gluconate and distilled water., Conclusion: Cetylpyridinium chloride 0.05% was the most effective storage solution in the reduction of total and individual microbial counts, including pathogenic species., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the influence of different toothpaste abrasives on the bristle wear and bristle tip morphology of toothbrushes with different degrees of hardness., Material and Methods: Ninety samples of bovine incisor teeth were used in this study. The samples were randomly divided into three groups according to the bristle hardness of the toothbrush used: soft bristles (S); extra-soft bristles (ES); hard bristles (H). The toothbrushes of each group were randomly divided into six subgroups with five toothbrushes each, according to the abrasive of the toothpaste used in the simulation: Negative control (distilled water); toothpaste 1 (silica); toothpaste 2 (hydrated silica); toothpaste 3 (calcium carbonate, calcium bicarbonate and silica); toothpaste 4 (tetrapotassium pyrophosphate, silica and titanium dioxide); toothpaste 5 (calcium carbonate). The samples were placed in a toothbrushing simulating machine that simulating three months of brushing. The toothbrush bristles were evaluated by the bristle wear index, and the bristle tips morphology was evaluated by the bristle tip morphology index., Results: The ES brush presented the highest bristle wear among the toothbrushes. Additionally, the S brushes showed better morphology of the bristles followed by ES and H brushes. The type of abrasive only influenced the bristle tip morphology of the ES brushes. The toothpaste 3 induced the worse bristle tip morphology than all the other toothpastes., Conclusions: Different abrasives have influence only on the bristle tip morphology of the ES brushes., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Nanoparticulate silver has recently been reported as an effective antimicrobial agent. The aim of this clinical study was to investigate the potential changes on the oral microbiota of healthy individuals after controlled brushing with chlorhexidine- or silver-coated toothbrush bristles. Twenty-four healthy participants were enrolled in this investigation and randomly submitted to 3 interventions. All the participants received, in a crossover format, the following toothbrushing interventions: (i) chlorhexidine-coated bristles, (ii) silver-coated bristles, and (iii) conventional toothbrush (Control). All the interventions had a duration of 30 days. The DNA checkerboard hybridization method was used to identify and quantify up to 43 microbial species colonizing the supra- and subgingival biofilm. The supragingival samples presented higher genome counts than the subgingival samples (p < 0.0001). The total genome counts from the Control group showed the highest values, followed by the silver and chlorhexidine groups (p < 0.0001). After 4 weeks of brushing, the silver-coated and chlorhexidine-coated bristles were capable of reducing or maintaining lower levels of the bacterial counts of the putative periodontal pathogens Tanerella forsythia, Treponema denticola, and Porphyromonas gingivalis. Other major periodontal pathogens, such as Prevotella intermedia, Fusobacterium nucleatum, Prevotella nigrescens, and Parvimonas micra, were also detected at lower levels. The toothbrush bristles impregnated with silver nanoparticles reduced the total and individual genome count in the supra- and subgingival biofilm after 4 weeks of brushing. Chlorhexidine was not effective in reducing the total genome counts in both supra- or subgingival biofilm after 4 weeks of brushing. Chlorhexidine reduced the individual genome counts in the supragingival biofilm for most of the target species, including putative periodontal pathogens.

Introduction: Oral impalement injuries are common in children. We report a case of severe pharyngeal toothbrush perforation in a 15-month-old infant., Observation: A 15-month-old child was admitted for a penetrating oral injury caused by a toothbrush. There was no hemorrhagic or neurological complication. A CT scan showed the toothbrush in the right parapharyngeal region with its extremity in the mastoid region. Exploration and extraction of the toothbrush was performed under general anesthesia. The outcome was uneventful., Discussion: Penetrating oral cavity wounds caused by a toothbrush in children may be severe and must be explored in the operating room. A preoperative CT scan must be performed to complete the assessment of lesions. The risk of infection is high and an antibiotic prophylaxis is recommended. Neurological and vascular complications may occur but they are rare., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objectives: To determine the effectiveness of a novel sonic toothbrush in reducing plaque and in maintenance of gingival health when compared to a standard manual brush., Methods: This study was a block-randomized, examiner-blind, two-treatment, parallel group, single centre clinical investigation. A total of 84 subjects were enrolled and randomly assigned to receive either the Panasonic EW-DL90 or an American Dental Association-endorsed manual toothbrush. Subjects were instructed to follow a twice-daily brushing regimen without flossing. Plaque levels and gingival health were assessed at baseline and after 1 and 3 weeks of treatment using the Turesky Modification of the Quigley-Hein Plaque Index and the Papillary Bleeding Score., Results: Subjects assigned to the EW-DL90 group had significantly lower plaque levels after 1 and 3 weeks of treatment than those in the manual group (P = 0.003 and 0.0035, respectively). Both groups showed a reduction in plaque levels at Week 3 relative to baseline. The EW-DL90 group had significantly lower gingival inflammation scores after 1 week of treatment (P = 0.0293), but there was no difference between groups after 3 weeks of treatment., Conclusion: The EW-DL90 toothbrush safely and effectively removes more plaque than a standard manual toothbrush. Improvement in gingival inflammation was observed after 1 week of treatment. There was no difference in Papillary Bleeding Score between the two groups after 3 weeks of treatment., Clinical Significance: The newly developed sonic brush (Panasonic EW-DL90) tested in this study was found to be more effective than a manual toothbrush at plaque removal. The papillary bleeding scores were significantly lower in the sonic brush group after 1 week of product use. After 3 weeks of product use, both treatment groups had similar papillary bleeding scores almost returning to baseline values., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aim of this in vivo study was to evaluate the efficacy of three antimicrobial solutions on the disinfection of toothbrushes after storage in closed containers., Materials and Methods: Sixteen healthy subjects were enrolled in this randomized cross-over clinical investigation. The study was conducted in four phases, in which mouthrinses (chlorhexidine gluconate-based or cetilpiridinium-based) and sterile tap water (control group) were used to individually store used toothbrushes in closed containers during 7 days of toothbrushing. Five toothbrushes were used as negative control for bacterial colonisation before contact with oral cavity. Conventional culture and DNA Checkerboard hybridization were used to detect bacterial contamination on the toothbrushes. Subsequently, the number of bacterial species on the bristles was estimated by the DNA Checkerboard method., Results: One toothbrush presented bacterial contamination in the negative control test. Both culture and DNA Checkerboard showed positive signals of bacterial contamination in the toothbrushes with no differences in the frequency of detection. The control group showed higher total bacterial counts when compared with the mouthrinse groups. Porphyromonas gingivalis had the highest bacterial count followed by Parvimonas micra., Conclusion: Culture and DNA Checkerboard showed positive signals of bacterial contamination. Mouthrinses that contains 0.12% of chlorhexidine gluconate were more effective in reducing bacterial colonisation on the toothbrushes., (© 2013 The Gerodontology Society and John Wiley & Sons A/S.)

Purpose: Microbial contamination of manual toothbrushes relative to their design has been documented for decades, citing concern for cross contamination and self-infection with microorganisms. A pilot study of different power toothbrushes was conducted, to compare a solid-head brush to 2 hollow-head brushes for residual contamination with commonly occurring oral microorganisms., Methods: Participants who met inclusion criteria were enrolled and brushed twice daily for 3 weeks with 1 of 3 randomly assigned power toothbrushes. Brush heads were vortexed and cultured using 5 appropriate media for oral microorganisms: anaerobes and facultative microorganisms, yeast and mold, oral streptococci and oral enterococci anaerobes, Porphyromonas gingivalis, and Fusobacterium species. Analysis of covariance was used to compare the brush groups for transformed microbial counts after adjusting for any demographic variables that may have confounded the results., Results: The solid-head power toothbrush was found to have significantly less microbial contamination than either of the 2 hollow-head power toothbrushes for all the bacteria tested and less than 1 of the hollow-head brushes for yeast and mold., Conclusion: The solid-head power toothbrush studied had significantly less residual microbial contamination than the 2 hollow-head power toothbrushes after 3 weeks of twice daily brushing with non-antimicrobial toothpaste., (Copyright © 2014 The American Dental Hygienists’ Association.)

Background: Toothbrushes are over-the-counter products; therefore, no special instruction is given to users when they purchase. There are scarce published studies that have investigated about how often toothbrushes should be replaced. Thus, this study aimed to verify the impact of the Progressive Toothbrush Bristle Flaring on plaque control efficacy of toothbrush., Materials and Methods: Thirty six subjects were randomly selected and underwent complete oral prophylaxis 10 days prior to the Baseline plaque recording. All subjects were provided with new similar toothbrushes and were divided into two groups. New Brush Group changed toothbrush every month and Old month Group used single toothbrush for the whole period of the study. Both groups were assessed for plaque accumulation every month using Turesky et al, (1970) modification of the Quigley and Hein (1962) plaque index. Toothbrush head was photographed and assessed by measuring the brushing surface area on standardized photographs using National Institutes of Health Image Analysis Program (USA)., Results: Both groups showed similar plaque scores at the 40(th) day; progressive increase in the plaque scores in group without changing the toothbrush were recorded at the 70(th) and 100(th) days. As toothbrush flaring increased, the plaque scores also increased in the Old Brush Group. Highest plaque accumulation was recorded in Mandibular Lingual aspects in Old Brush Group., Conclusion: Progressive increase was seen in the plaque scores with increase in toothbrush bristle flaring.

Toothbrush, the innocent cleaning aid, has been reported to cause life threatening oropharyngeal injuries in pediatric literature. A case of a 4-year-old child reporting to an emergency department with a toothbrush impaled in her mouth while her father was forcefully brushing her teeth is reported here. Hemostasis was achieved by digital pressure and the impaled toothbrush was removed surgically. Uneventful recovery was noted. Parental anxiety and a lack of patient cooperation was noted. Such impaled objects fractured and left behind have been reported to cause serious space infections and mediastinitus. Advising parents to be careful with their children's toothbrush is important as prevention of injuries from such commonly used object could be easily achieved., (© 2011 Blackwell Publishing Asia Pty Ltd.)